Health Expect. 2026 Oct;29(5):e70896. doi: 10.1111/hex.70896.
ABSTRACT
INTRODUCTION: Colorectal cancer surgery has a higher risk of complications for patients carrying excess weight. Preoperative weight loss might reduce this risk. However, it is unclear how patients perceive engagement with an intensive weight-loss programme in the short window between diagnosis and surgery. This qualitative study, embedded within the CARE randomised controlled trial, aimed to understand the acceptability and experiences of following an intensive weight-loss programme with dietetic support as prehabilitation before colorectal cancer surgery.
METHODS: Thirty-one participants (65% male, mean (SD) BMI 36.0 (5.5) kg/m2, 65 (7) years) took part in a semi-structured interview based on the Theoretical Framework of Acceptability after following the programme for an average of 24 (12) days and 12 (7) days before surgery. Data were thematically analysed using the four constructs of Normalisation Process Theory (NPT).
RESULTS: Participants understood, via interactions with healthcare professionals, that the programme could potentially make their operation technically easier and expedite hospital discharge (coherence). Continued adherence was supported by the dietitians (cognitive participation), and improvements in health markers and rapid weight loss helped to reframe some participants’ views that their bodies were failing due to cancer (reflexive monitoring). However, some families’ distrust of the programme’s safety, social eating occasions, and side effects prevented full acceptability and total adherence (collective action). This highlighted how collective action sometimes overrode the consistently strong coherence, cognitive participation, and reflexive monitoring components of NPT.
CONCLUSION: The weight-loss programme was mostly acceptable to people who had already joined the intervention. Addressing challenges with collective action may support more patients to adhere.
CLINICAL TRIAL REGISTRATION: ISRCTN39207707, Registration date 13/03/2023.
PMID:42841450 | DOI:10.1111/hex.70896
